EMT-Basic Exam: The Basics of Baseline Vital Signs and SAMPLE History

Preparatory questions also assess your knowledge of taking baseline vital signs and completing a SAMPLE history. Remember that baseline vital signs are those you take when you first come into contact with a patient. You later use these signs when you reassess the patient. Changes in vital signs indicate changes in the patient’s condition. The SAMPLE history is information you gather about a patient and his or her medical condition.

1. Baseline Vital Signs
Note the following when you are assessing baseline vital signs:
Breathing: Watch the patient breathe. During one complete breath, the patient’s chest will rise and then fall. Count the number of breaths the patient takes in 30 seconds, and then multiply this number by 2 to determine the number of breaths per minute. Note that breathing is also referred to as respiration. The following are normal respiration rates:
- Adults: 12–20 respirations per minute
- Small children: 20–30 respirations per minute
- Infants: greater than 30 respirations per minute

Also note the quality of a patient’s respirations. The patient’s chest should expand. Breathing should sound clear and not noisy.
Pulse: When you take a patient’s pulse, note that a rate of 60–100 is normal for adults. The pulse of children and elderly patients may be faster. A patient’s pulse should be strong and regular. A weak pulse is a sign of shock.
Skin: EMT-Basics note the patient’s skin color when assessing baseline vital signs. Skin color is assessed in the nail beds, inside the mouth (oral mucosa), and inside the lower eyelid (conjunctiva). The normal color of skin in these areas is pink, regardless of whether the patient has light or dark skin. Assess the soles of the feet or the palms in children and infants for capillary refill time. Pale skin color indicates a lack of blood flow. A patient with flushed skin may have been exposed to heat or carbon monoxide.
Pupils: A patient’s pupils should be normal and equal in size. The pupils should constrict when you shine a penlight in the eyes and then dilate when the light is removed. A patient whose pupils don’t react to light may have a head injury or may have ingested medications that affect pupil dilation.
Blood pressure: As you may remember, systolic blood pressure is a measurement of the pressure against the walls of the arteries as the heart contracts. Diastolic blood pressure is a measurement of the pressure against the walls of the blood vessels as the heart relaxes. In adults, normal blood pressure is 120/80 (systolic/diastolic). Blood pressure is lower in children but increases as they grow older. In a 5-year-old child, normal blood pressure is 90/52, and in a 10-year-old child, normal blood pressure is 100/60.

2. SAMPLE History
A SAMPLE history is a medical history, which EMT-Basics obtain from the patient, his or her family, and bystanders. The information you obtain during a SAMPLE history should be documented accurately, clearly, and concisely. SAMPLE is an acronym to help you remember the six elements of this history:
Signs and symptoms: A sign is a medical condition you can observe in a patient, such as skin color. A symptom is a condition that the patient describes, such as nausea, that you can’t see.
Allergies: Always ask patients if they are allergic to medications, foods, or anything in the environment. Some people are allergic to penicillin or sulfa drugs. Others are allergic to milk or shellfish. Common allergens in the environment include grass and other plants. Check for medical alert tags. Determining a patient’s allergies can help you determine if the patient has had an allergic reaction.
Medications: Ask a patient what medications he or she is taking. Inquire as to both prescribed and over-the-counter medications. If medication is prescribed, ask if it is being taken as directed.
Pertinent past medical history: Ask the patient about past medical problems, surgeries, and injuries.
Last oral intake (solid or liquid): Ask the patient to indicate the time and amount of food and liquid he or she last consumed.

Events leading to the injury or illness: Have the patient identify the events leading to the injury or illness. If the patient has chest pain, note whether the patient was active or resting when the pain first occurred. Use the acronym OPQRST to help you question the patient:
- O—onset (when the problem first occurred)
- P—provocation (what makes it better or worse)
- Q—quality (the patient’s description of signs or symptoms)
- R—radiation (whether the pain moves to another location)
- S—severity (on a scale from 0 to 10, with 0 meaning no symptoms)
- T—time (the length of time the condition has been present)

Additional Topic to Review
- Vital sign reassessment